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NPI Code Detail

MEDICARE: LIVING TREE MEDICAL GROUP

MEDICARE: LIVING TREE MEDICAL GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0100XHealth Service Clinic/Center
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1639754583
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIVING TREE MEDICAL GROUP
Provider Business Mailing Address
First Line : 1635 N 200 E
Second Line :
City : LOGAN
State : UT
Zip : 84341-1913
Country : US
Telephone Number : 435-565-6043
Fax Number : 435-220-2030
Provider Business Practice Location Address
First Line : 1635 N 200 E
Second Line :
City : LOGAN
State : UT
Zip : 84341-1913
Country : US
Telephone Number : 435-565-6043
Fax Number : 435-215-4420
Authorized Official
Title or Position : COC
Name : KRIS COLEMAN
Credential :
Telephone Number : 435-770-2131
Provider Enumeration Date : 03/12/2021
Last Update Date : 07/11/2025

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Directions to “LIVING TREE MEDICAL GROUP ” Practice Location

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